Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH043821 | GA |
NPI | 1033795398 |
---|---|
Provider Name | Netoya Johnson |
First Address | Fairburn, GA 30213-5503 |
Second Address | Fairburn, GA 30213-5503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2021 |
Last Update Date | 18/03/2021 |